Hybrid Case Management Analyst

at CVS Health

• Job title: Case Management Analyst
• Job type: Full Time
• Experience level: Junior, Mid level
• Salary: $21 - $45 per hour
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Rockford, United States

About the role

• Analyst, Case Management Field position for Aetna’s LTSS team in Illinois, requiring 50-75% travel to meet members. Focus on care coordination and healthcare outcomes for waiver members.

Responsibilities

• This Analyst, Case Management Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position out of the Winnebago County/Rockford area in Illinois.
• The requirements is for candidates to travel 50-75% of the time to meet with members face to face.
• This position holds a full caseload to manage waiver members.
• This position requires in person quarterly visits with members.
• Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.
• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Must reside in the state of Illinois in Winnebago County IL or Surrounding Areas
• Case management experience
• Microsoft Office and electronic health record experience
• Valid Illinois Driver’s license
• Willing and able to travel up to 75% of their time to meet with members face to face
• Reliable Transportation required, eligible for mileage reimbursement as per company policy
• Case management and discharge planning experience preferred (2 years)
• Managed Care experience preferred
• Microsoft Office experience preferred
• Bachelor’s degree or a non-licensed individual with a master’s degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access